Prescription order fulfillment and administration of drugs to patients are important tasks which require the exercise of considerable care to ensure that the patient receives the correct drug in accordance with the physician's instructions. Because of the importance that prescription orders be fulfilled correctly, a registered pharmacist is required to review each prescription order and to verify that the prescription order has been fulfilled correctly. This prescription order review and verification process is performed before the prescription order is provided to the patient and before any drugs are administered to the patient to ensure that the patient receives the appropriate medical treatment.
Registered pharmacist prescription order review and verification is a time-consuming and relatively costly process. The registered pharmacist review and verification process can increase the cost of delivering high-quality patient care. The healthcare industry is under constant pressure to control these costs. Moreover, registered pharmacists are highly-skilled professionals whose time is valuable and can be spent, for example, performing other important tasks such as counseling patients.
Pharmacies are increasingly reliant on automation in order to improve the quality of patient care and to control healthcare costs. One highly-effective application of pharmacy automation is the use of automatic drug dispensing and packaging machines, referred to herein simply as automatic drug packaging machines. The automatic drug packaging machines may package the drugs in what are known as “compliance packages.” Compliance packages organize the drugs in some useful manner to facilitate compliance with the physician's instructions.
One type of compliance package output by an automatic drug packaging machine is referred to in industry as a “pouch package.” Pouch packages are formed serially in a web of pouch packaging material with each pouch package containing a drug “dose” consisting of one or more drugs. The drugs may be in tablet form or in other forms, such as granular or powdered form. The web of pouch packages output from the automatic drug packaging machine is sometimes referred to as a “vine.” Each pouch package is a separate, sealed drug-containing package formed in the pouch package web, or vine. The pouch package web can be as long as required by the pharmacy or other automatic drug packaging machine operator. To facilitate compliance, the automatic drug packaging machine prints useful information on each pouch package, such as the patient name, drug information, and instructions for administration of the drug. The automatic drug packaging machine is computer controlled and may be programmed to output any number and sequence of pouch packages. An automatic drug packaging machine can operate for many hours, for example overnight, without human intervention.
Pouch packages are a useful type of compliance package because the packages may be output from the automatic drug packaging machine ordered in any suitable manner, such as by the particular time of day at which the drug in each pouch is to be taken, (e.g., breakfast, lunch, and dinner). The pouch package web may be cut into smaller portions corresponding to each patient's prescription order and then may be provided to the patient. The patient then takes each drug one-after-the-other in the sequence in which the pouch packages are provided.
Pouch-package-type compliance packages are highly effective for drug administration at in-patient facilities, such as hospitals and long-term care facilities (e.g., nursing homes). This is because the pouch packages can be generated for many patients and can be grouped and organized in order of administration, thereby facilitating implementation of the physician's instructions and improving the quality of patient care.
While automatic drug packaging machines are excellent for their intended purpose, any automatic process carries with it the possibility of incorrect operation. For example, there may be a rare circumstance in which the wrong drug is packaged in the pouch package. There may be a rare circumstance in which a mismatch exists between a given pouch and the drug expected to be loaded in that pouch, potentially causing a series of drug and pouch package mismatches. There is also a limited possibility of printer error or malfunction so that the information printed on each package is not legible, or is unusable.
In these rare circumstances, pharmacy personnel must take corrective steps because the drugs cannot be administered unless the pharmacy is confident that the prescription order is correct and that any important printed information is usable. The corrective steps could involve discarding the pouch packages or expending valuable human time to manually remove the drugs from the pouch packages and to restock the drugs.
As valuable as automatic drug packaging machines are, the foregoing infrequent issues illustrate the importance of registered pharmacist prescription order review and verification before the pouch packages comprising a patient prescription order are administered to a patient. This review and verification is routinely performed by manually handling and checking each pouch package against printed or displayed information corresponding to the patient prescription order.
As can be appreciated, manual handling and review and verification of pouch packages is a slow and tedious process. Each pouch package web, or vine, may include many hundreds of look-alike pouch packages. The manual review and verification process is potentially subject to error because of the repetitive nature of the process and the look-alike appearance of the pouch packages. Therefore, while automatic drug packaging machines provide improvements in dispensing and packaging of the drugs, the prescription order fulfillment process is not optimally efficient because of the limitations imposed by the manual review and verification process of the pouch packages output from the automatic drug packaging machine.
Various inspection devices have been proposed to facilitate pouch package inspection. For example, U.S. Pat. No. 6,330,351 describes a pouch package drug inspection device in which a camera-generated image of the actual pouch package content is compared with a reference image of the content. However, the drug inspection device is disadvantageous at least because it is incapable of detecting pouch package loading errors in real time as the pouch packages are output from the automatic tablet packaging machine.
A further pouch package inspection device is described in U.S. Pat. No. 7,540,222. This patent describes a manual inspection system in which a user manually examines an enlarged camera-generated image of each pouch package for printing errors or for broken tablets. The inspection device is disadvantageous, however, at least because it is limited to manual detection of printing and tablet-damage errors and is not a prescription order verification system.
There is a need for an automatic drug packaging machine and package-less verification system which would address some or all of the foregoing needs, including needs of in-patient facility pharmacies and pharmacies generally, which would facilitate reliable and accurate prescription order review and verification, which would reduce the cost of prescription order review and verification, which would provide automatic “real time” detection of packaging errors thus avoiding creation of incorrectly-packaged pouch package webs, which would permit rapid and accurate verification of each pouch package without the need to physically handle any pouch package, and which would generally improve the quality of patient care.